Provider Demographics
NPI:1760828073
Name:ANDERSON, RHONDA LEIGH (RN)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:LEIGH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:PO BOX 329
Mailing Address - Street 2:
Mailing Address - City:SHIPSHEWANA
Mailing Address - State:IN
Mailing Address - Zip Code:46565-0329
Mailing Address - Country:US
Mailing Address - Phone:260-593-0108
Mailing Address - Fax:260-593-0116
Practice Address - Street 1:730 E. NORTH STREET
Practice Address - Street 2:
Practice Address - City:SHIPSHEWANA
Practice Address - State:IN
Practice Address - Zip Code:46565-9476
Practice Address - Country:US
Practice Address - Phone:260-593-0108
Practice Address - Fax:260-593-0116
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71004463A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ1578Medicaid